100+ Free ABP Child Abuse Pediatrics Practice Questions

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Question 1

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A 3-month-old infant presents with lethargy and a bulging fontanelle. Head CT shows bilateral subdural hematomas of varying ages. Dilated fundoscopy reveals numerous multilayered retinal hemorrhages extending to the ora serrata in both eyes. Which diagnosis is most strongly supported?

Benign external hydrocephalus of infancy

Accidental short fall from a couch

Abusive head trauma (AHT)

Glutaric aciduria type I

to track

2026 Statistics

Key Facts: ABP Child Abuse Pediatrics Exam

~200

Total MCQ Items

Single-best-answer, 4-5 options

~7 hr

Exam Time

1-day CBT at Pearson VUE

180

Passing Score

1-300 scale; criterion-referenced

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME-accredited Child Abuse Pediatrics

Annual

2026 Administration

Offered annually at Pearson VUE

The ABP Child Abuse Pediatrics certifying exam is a 1-day computer-based test of approximately 200 single-best-answer MCQs delivered at Pearson VUE. Scored on a 1-300 scale with 180 passing (criterion-referenced, modified Angoff). The 2026 fee is $2,992 regular ($750 processing), $3,337 late. Highest-yield domains: abusive head trauma (~15%), skeletal injury/fractures (~12%), cutaneous injury/burns/bites (~12%), sexual abuse medical evaluation (~13%), neglect/FDIA (~10%), abdominal/visceral trauma (~6%), fatal abuse/SUID (~6%), differential diagnosis mimics (~8%), forensic interviewing (~6%), mandated reporting and court testimony (~6%), psychosocial/prevention (~4%), and ethics (~2%).

Sample ABP Child Abuse Pediatrics Practice Questions

Try these sample questions to test your ABP Child Abuse Pediatrics exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 3-month-old infant presents with lethargy and a bulging fontanelle. Head CT shows bilateral subdural hematomas of varying ages. Dilated fundoscopy reveals numerous multilayered retinal hemorrhages extending to the ora serrata in both eyes. Which diagnosis is most strongly supported?

A.Benign external hydrocephalus of infancy

B.Accidental short fall from a couch

C.Abusive head trauma (AHT)

D.Glutaric aciduria type I

Explanation: Multilayered retinal hemorrhages extending to the periphery (ora serrata) combined with subdural hematomas of varying ages in an infant have very high specificity for abusive head trauma. Short falls rarely produce this pattern. BESS can predispose to subdural but not the retinal findings; glutaric aciduria T1 can mimic but is excluded by acylcarnitine/urine organic acids.

2Which term is preferred by the American Academy of Pediatrics over 'shaken baby syndrome'?

A.Whiplash shaken infant syndrome

B.Nonaccidental head injury only

C.Abusive head trauma (AHT)

D.Inflicted traumatic brain injury

Explanation: Since the 2009 AAP policy statement, 'abusive head trauma' is the preferred umbrella term because it encompasses shaking, blunt impact, and shaking-impact mechanisms without committing to a single biomechanical cause. This terminology is more defensible in court and clinically inclusive.

3Bridging vein rupture producing subdural hemorrhage in AHT most likely results from which biomechanical force?

A.Vasogenic edema from hypoxia alone

B.Pure translational (linear) forces

C.Static compression of the calvarium

D.Rotational/angular acceleration-deceleration of the head

Explanation: Bridging veins cross the subdural space between cortex and dural sinuses. Rotational/angular acceleration and deceleration creates shear strain that tears these veins, producing subdural hemorrhage. Pure translational forces typically cause focal contact injuries (skull fractures, epidural).

4A 5-month-old presents with seizures. MRI shows diffuse axonal injury at the gray-white junction, subdural hematoma over the convexities, and cervicomedullary junction injury. What pattern does this suggest?

A.Hypoxic-ischemic encephalopathy of the newborn

B.Birth-related subdural hemorrhage

C.Inflicted rotational injury consistent with AHT

D.Arachnoid cyst rupture

Explanation: Diffuse axonal injury, cervicomedullary injury (brainstem/upper cord), and subdural hemorrhage together reflect rotational shearing forces characteristic of AHT. Birth-related subdurals resolve by ~4 weeks and lack DAI. This constellation strongly suggests inflicted injury.

5Which metabolic disorder classically mimics AHT with subdural hemorrhages and macrocephaly and must be excluded?

A.Maple syrup urine disease

B.Phenylketonuria

C.Glutaric aciduria type I

D.Galactosemia

Explanation: Glutaric aciduria type I (GA1) can cause macrocephaly, frontotemporal atrophy with widened subarachnoid spaces, and subdural hemorrhages, mimicking AHT. Diagnosis by urine organic acids (elevated glutaric and 3-hydroxyglutaric acid) and plasma acylcarnitines (elevated C5DC).

6Benign enlargement of the subarachnoid space (BESS) is considered a risk factor for which finding after minor trauma?

A.Intraparenchymal hemorrhage

B.Epidural hemorrhage

C.Subdural hemorrhage

D.Cortical contusion

Explanation: BESS (macrocephalic infants with enlarged subarachnoid spaces) may predispose to subdural hemorrhage with minor trauma due to stretched bridging veins. However, BESS does not cause retinal hemorrhages or DAI; these require separate explanation and should prompt evaluation for abuse.

7A 2-year-old fell off a 3-foot couch onto carpet. Evidence-based literature indicates the risk of life-threatening head injury from such a short fall is:

A.Identical to adult falls from same height

B.High; up to 30% risk of severe TBI

C.Unknown; cannot be estimated

D.Extremely low (<1 per million); severe intracranial injury should prompt concern for abuse

Explanation: Peer-reviewed biomechanics and epidemiology (e.g., Chadwick et al., Hall et al.) show fatal or severe TBI from short household falls (<4 feet) occurs at rates on the order of <1 per million. Severe intracranial findings in this setting warrant investigation for AHT.

8Retinal hemorrhages in AHT are most specific when they are:

A.A few intraretinal dot hemorrhages limited to the posterior pole

B.Too numerous to count, multilayered (preretinal/intraretinal/subretinal), and extend to the periphery

C.Unilateral and flame-shaped only

D.Present only in the vitreous

Explanation: High specificity for AHT is conferred by hemorrhages that are numerous, multilayered, and extend out to the ora serrata, often with retinoschisis. Few posterior-pole hemorrhages are nonspecific and may be seen with birth, CPR, coagulopathy, or elevated ICP.

9Osteogenesis imperfecta (OI) is in the AHT/skeletal-injury differential. Which gene defect causes the most common types I-IV?

A.ATP7A (copper transport)

B.COL1A1 or COL1A2 (type I collagen)

C.CFTR (chloride channel)

D.DMD (dystrophin)

Explanation: Classic OI (types I-IV) is caused by autosomal dominant mutations in COL1A1 or COL1A2 encoding alpha chains of type I collagen. Clinical clues include blue sclerae, hearing loss, dentinogenesis imperfecta, Wormian bones, and low bone density, though mild OI can lack many features.

10A 4-month-old has a subdural hematoma. Caregiver reports no trauma. Which imaging is most appropriate as part of the workup?

A.Skull x-ray only

B.Skeletal survey plus MRI brain/spine and dilated fundoscopy

C.Abdominal ultrasound only

D.Repeat head CT in 6 months, no further imaging now

Explanation: AAP and ACR guidance: when AHT is suspected, evaluation includes a skeletal survey (AP/lateral views), MRI of brain and cervical spine, and dilated ophthalmologic exam by ophthalmology. This detects occult fractures, ligamentous injury, DAI, and retinal findings.

About the ABP Child Abuse Pediatrics Exam

The ABP Child Abuse Pediatrics subspecialty certifying exam validates expert-level knowledge of abusive head trauma (AHT/SBS), skeletal injury (CML, posterior rib, multiple stages of healing), cutaneous injury (bruising patterns, bites, burns — immersion/patterned/scald), sexual abuse medical evaluation (2023 Adams classification, STI testing, nPEP), neglect and medical child abuse (FDIA), abdominal/visceral trauma, SUID investigation, differential diagnosis (OI, rickets, Menkes, bleeding disorders, Mongolian spots), forensic interviewing, mandated reporting, and court testimony. Offered annually as an ABP subspecialty CBT at Pearson VUE. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited Child Abuse Pediatrics fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~7 hours with breaks)

Passing Score

Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)

Exam Fee

$2,992 regular ($750 processing fee); $3,337 with late fee (American Board of Pediatrics (ABP) / Pearson VUE)

ABP Child Abuse Pediatrics Exam Content Outline

~15%

Abusive Head Trauma (AHT)

Biomechanics of acceleration-deceleration and impact, retinal hemorrhages (multilayered, to ora serrata), retinoschisis, subdural hematoma, cortical contusional tears, shearing/DAI, PRES, subdural dating, BESS, differential (birth trauma, coagulopathy, glutaric aciduria type 1).

~13%

Sexual Abuse Medical Evaluation

History (minimal facts), anogenital exam (labial traction, knee-chest), normal variants, 2023 Adams classification, forensic kit timing (~96h prepubertal, ~120h adolescent), STI NAAT/HIV/syphilis/HBV/HCV/HSV, HIV nPEP <72h, emergency contraception, colposcopy, differential (straddle, lichen sclerosus, urethral prolapse).

~12%

Fractures — Skeletal Injury

Classic metaphyseal lesion (CML — bucket-handle/corner, infant <1y), posterior rib fractures, spiral/oblique long bones in non-ambulatory infants, multiple skull fractures, multiple stages of healing (periosteal reaction/callus/remodeling dating), skeletal survey protocol (ACR, 2-week follow-up), differential (OI COL1A1/2, rickets, Menkes).

~12%

Cutaneous Injury — Bruises, Bites, Burns

TEN-4-FACESp rule, sentinel injuries in non-ambulatory infants <4mo, bruising patterns (loop, linear, slap), human bite marks (3cm intercanine), patterned burns, immersion/scald (stocking/glove, clear waterlines, sparing of flexural creases), zebra/donut pattern, differential (Mongolian spots, HSP, phytophotodermatitis, coining).

~10%

Neglect and Medical Child Abuse (FDIA)

Physical/medical/educational/supervisional/emotional neglect, failure to thrive (organic vs nonorganic), medical neglect, supervisional lapses (drowning/ingestion/firearm), Munchausen by proxy / FDIA (DSM-5-TR), fabrication vs induction, separation test, safety planning.

~8%

Differential Diagnosis and Mimics

Osteogenesis imperfecta, rickets (vit D, hypophosphatasia ALPL), Menkes (ATP7A), EDS, bleeding disorders (hemophilia, vWD, ITP, HSP, factor XIII, vit K HDN), leukemia, dermal melanocytosis, cultural practices (cao gio, cupping), glutaric aciduria type 1, arachnoid cysts, birth trauma.

~6%

Abdominal and Visceral Trauma

Duodenal hematoma, pancreatic pseudocyst, mesenteric laceration, solid organ injury (liver/spleen/kidney/adrenal), hollow viscus, delayed presentation, AST/ALT >80 IU/L screening, lipase, chest trauma (ribs, contusion), strangulation (petechiae, ligature).

~6%

Fatal Child Abuse and SUID

Child fatality review, SUID/SIDS (triple-risk model), unsafe sleep, scene investigation (doll reenactment), accidental asphyxia vs inflicted, drowning, homicide determination, role of forensic pathologist.

~6%

Forensic Interviewing

Child Advocacy Centers (multidisciplinary team), NICHD/RATAC/ChildFirst protocols, developmentally appropriate open-ended questioning, suggestibility, disclosure (delayed/partial/recanted), hearsay exceptions, video recording.

~6%

Mandated Reporting and Court Testimony

Mandated reporter statutes (all states), reasonable suspicion standard, good-faith immunity, CPS investigation, family vs dependency vs criminal court, expert witness role, Daubert/Frye standards, fact vs opinion, documentation, cross-examination prep.

~4%

Psychosocial Aspects and Prevention

Adverse Childhood Experiences (ACEs), risk/protective factors, trauma-informed care, evidence-based parenting (Triple P, PCIT, SafeCare), home visiting (NFP), Period of PURPLE Crying (AHT prevention).

~2%

Ethics, Culture, and Systems

Reporting vs confidentiality, race/ethnicity disparities in evaluation, photography consent, research ethics, cultural humility, immigrant/refugee families, LGBTQ+ youth.

How to Pass the ABP Child Abuse Pediatrics Exam

What You Need to Know

Passing score: Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT (~7 hours with breaks)
Exam fee: $2,992 regular ($750 processing fee); $3,337 with late fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABP Child Abuse Pediatrics Study Tips from Top Performers

1Classic metaphyseal lesion (CML) rule: the bucket-handle and corner fractures are pathognomonic of abuse in infants <1 year and result from shearing/torsional forces (not direct blows). They are most commonly at the distal femur, proximal/distal tibia, and proximal humerus. Always order a skeletal survey and a follow-up survey in 2 weeks per ACR guidelines to detect healing fractures not visible acutely.

2TEN-4-FACESp sentinel injury rule: Bruising on the Torso, Ear, Neck in any child ≤4 years; any bruising in infants <4 months; or bruising of Frenulum, Auricular area, Cheek, Eyelid, Subconjunctival hemorrhage, and Patterned marks is highly concerning for abuse. Any bruise in a pre-cruising infant ('those who don't cruise rarely bruise') is a sentinel injury mandating full evaluation.

3Abusive head trauma (AHT) retinal findings: multilayered hemorrhages extending to the ora serrata with retinoschisis are highly specific for AHT — accidental household falls rarely cause such findings. Always obtain a dilated indirect ophthalmologic exam by pediatric ophthalmology within 72 hours. Differential includes severe accidental trauma (MVC with severe head injury), coagulopathy, leukemia, and (rarely) CPR — but CPR does NOT produce extensive multilayered RHs.

4Sexual abuse forensic evaluation timing: most jurisdictions recommend forensic (SAFE) kit collection within 96 hours for prepubertal children and 120 hours for adolescents — check your state protocol. HIV nPEP must start within 72 hours (prefer within 2 hours). Use the 2023 Adams classification: 'normal' or 'nonspecific' findings DO NOT exclude abuse — the exam is normal in most disclosed sexual abuse cases.

5Differential diagnosis cornerstones: in suspected fractures, evaluate for OI (COL1A1/COL1A2 — blue sclerae, dentinogenesis imperfecta, hearing loss, positive family history, DEXA), rickets (low 25-OH-D, elevated ALP/PTH, wrist/costochondral changes), hypophosphatasia (low ALP), and Menkes (kinky hair, ATP7A). In suspected bruising, evaluate for ITP (low platelets), vWD, hemophilia, HSP (palpable purpura on buttocks/legs + arthritis/GI + IgA deposits). In AHT, rule out glutaric aciduria type 1 with urine organic acids/acylcarnitines (frontotemporal atrophy, macrocephaly).

Frequently Asked Questions

What is the ABP Child Abuse Pediatrics subspecialty certification?

The ABP Child Abuse Pediatrics certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert-level knowledge in the medical evaluation of suspected child physical abuse, sexual abuse, neglect, and medical child abuse (FDIA). It qualifies diplomates to lead hospital-based Child Protection Teams, staff Child Advocacy Centers, serve as expert witnesses, and provide consultation to child welfare and law enforcement.

Who is eligible to take the ABP Child Abuse Pediatrics exam?

Candidates must hold primary ABP General Pediatrics certification in good standing and have completed 3 years of full-time training in an ACGME-accredited Child Abuse Pediatrics fellowship. A valid unrestricted medical license is required. The fellowship includes clinical evaluation, forensic interviewing exposure, expert testimony preparation, and scholarly activity meeting the ABP scholarly requirement.

What is the format of the ABP Child Abuse Pediatrics exam?

It is a 1-day computer-based exam administered at Pearson VUE Professional Testing Centers, consisting of approximately 200 single-best-answer multiple-choice questions. Questions have 4-5 options with exactly one correct answer. Items include clinical vignettes with imaging (skeletal surveys, head CT/MRI, retinal photos), photographs of cutaneous injuries, and scenarios covering forensic interviewing, reporting, and expert testimony.

How much does the 2026 ABP Child Abuse Pediatrics exam cost?

The 2026 regular registration fee is $2,992, which includes a $750 nonrefundable processing fee. Late registration is $3,337 (includes a $345 late fee). Child Abuse Pediatrics is administered annually as an ABP subspecialty exam at Pearson VUE centers.

How is the exam scored?

The exam is scored on a 1-300 scale with 180 designated as the passing mark. ABP uses a criterion-referenced scoring model: a panel of practicing, board-certified Child Abuse Pediatrics physicians determines the passing standard using the modified Angoff method. Results are reported as scaled scores, not percentile ranks.

What are the highest-yield topics?

Abusive head trauma (~15%), skeletal injury (~12%), cutaneous injury (~12%), and sexual abuse evaluation (~13%) collectively cover about half the exam. Master AHT biomechanics and retinal findings, the classic metaphyseal lesion (CML) and posterior rib fractures, TEN-4-FACESp bruising rule and sentinel injuries in non-ambulatory infants, immersion/scald burn patterns, the 2023 Adams classification of anogenital findings, HIV nPEP/STI testing timing, and the differential diagnosis (OI, rickets, Menkes, bleeding disorders, glutaric aciduria type 1).

How should I study for this exam?

Use a 6-12 month structured plan during your final fellowship year. Start with physical abuse — AHT, fractures, and cutaneous injury (highest-yield). Move to sexual abuse evaluation using the 2023 Adams classification. Then neglect, FDIA, abdominal trauma, SUID, and differential diagnosis/mimics. Finish with forensic interviewing, mandated reporting, and court testimony. Take 2-3 timed full-length mock exams. Integrate Jenny's 'Child Abuse and Neglect' textbook, AAP SOCAN clinical reports, APSAC guidelines, and Ray E. Helfer Society resources.

What are my continuing certification requirements after passing?

After initial certification, diplomates maintain certification via the ABP's Maintenance of Certification Assessment for Pediatricians (MOCA-Peds) — a longitudinal assessment with quarterly questions over a 5-year cycle. Diplomates must also complete Part 2 (self-assessment CME) and Part 4 (improvement in medical practice) activities and maintain an unrestricted license.